ORIGINAL RESEARCH article
Front. Public Health
Sec. Health Economics
Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1611102
This article is part of the Research TopicHealth Policy Approaches to Chronic Disease ManagementView all 13 articles
Spatiotemporal Inequality and Financial Toxicity of Leukemia in Post-Poverty China: A National Analysis of 832 Counties (2019-2024)
Provisionally accepted
- 1Naval Medical University, Shanghai, China
- 2China Population and Development Research Center, Beijing, China
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Background: Leukemia remains a critical public health challenge in China's post-poverty regions, where high treatment costs perpetuate the "disease-poverty" trap. Despite nationwide efforts to improve healthcare access, the evolving spatiotemporal dynamics and economic burden of leukemia in these regions remain understudied. Methods: Using population-based data from China's Health Poverty Alleviation Platform (2019-2024), we analyzed 97,472 leukemia cases across 832 poverty-alleviated counties. Age/sex-standardized incidence and mortality rates were calculated using 2020 census data. Spatiotemporal trends were evaluated via Joinpoint regression, and spatial clustering was mapped through global/local Moran's I and Getis-Ord Gi* analyses. The economic burden was assessed by Out-Of-Pocket (OOP) payment ratios and costs. Results: Longitudinal analysis of 97,472 leukemia cases across 832 Chinese poverty-alleviated counties (2019-2024) revealed: (1) Significant reductions in age-standardized incidence (AAPC = -59.4%, P = 0.015) and mortality (AAPC = -67.5%, P = 0.012), with persistently higher male incidence (χ² = 1554.4, P < 0.001); (2) Spatiotemporal transition from Northeast/Central clustering (Moran's I > 0.38, P < 0.001; 2019-2021) to Western hotspot expansion (Getis-Ord Gi*, P < 0.001; 2022-2024), indicative of improved diagnostic coverage;(3) Severe financial toxicity in Eastern China (median OOP ratio = 39.7%, approaching WHO catastrophic thresholds) and high absolute OOP cost clustering in Central regions, driven by therapy costs and insurance fragmentation. Conclusion: While China's poverty alleviation policies effectively reduced the leukemia burden, persistent regional disparities and financial toxicity demand targeted interventions. The westward hotspot migration post-2022 marks a diagnostic catch-up in resource-limited regions. Crucially, elevated male/youth incidence necessitates targeted screening in emerging clusters, while diverging financial toxicity demands region-specific solutions: for Eastern China's catastrophic OOP ratios (39.7%), reform must prioritize novel-therapy reimbursement; Central China's cost-clustering urges cross-provincial care networks to offset abandonment risks.
Keywords: Leukemia, China, Poverty-Alleviated Regions, spatiotemporal analysis, Financial toxicity
Received: 01 May 2025; Accepted: 01 Sep 2025.
Copyright: © 2025 Li, Lv, XIA, Chen, Wang, Chen and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Lulu Zhang, Naval Medical University, Shanghai, China
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